Qof kasta oo qaba cudurrada xididada wadnaha (CAD) wuxuu u baahan yahay daaweyn khatar ah iyo isbeddel ku yimaada isbeddelka, labadaba si loo yareeyo khatarta wadno-qabadka , iyo in la xakameeyo astaamaha angina (haday jirto).
Mararka qaarkood daweynta daaweynta keligeed ma ahan mid ku filan, iyo daaweynta revascularization ayaa loo baahan yahay. Dib-u-celinta macnaheedu waa in xayiraadaha muhiimka ah ee xididdada halbowlayaasha ay ku yaraanayaan anjioplasty iyo stent , ama qalliinka boogaha (sidoo kale loo yaqaan 'coronary artery bypass stabbing', ama CABG).
Sidaa darteed, qof kasta oo laga helo CAD, dhakhtarka iyo bukaan-socodka waa inay tixgeliyaan laba su'aalood. Marka hore, waa daaweyn caafimaad kaliya oo ku filan, ama waa in dib loo eegaa dib-u-celinta? Marka labaad, haddii revascularization lagu taliyo, waa in ay la socotaa stenting, ama CABG?
Goorma Dib Loogu Celiyaa?
Dadka badankood ee haysta CAD, daaweyn caafimaad , oo ay weheliso hab nololeed haboon oo lagu hagaajinayo khatarta wadnaha , waa inay noqotaa qaabka doorashada. Gaar ahaan, dadka qaba hunguriga xasaasiga ah (angina oo la saadaalin karo bilawga, taasina waxay dhacdaa oo kaliya xaaladaha gaarka ah sida jimicsiga), daaweynta caafimaad waxay waxtar u leedahay sida dib-u-celinta ka hortagga wadnaha wadnaha, iyo dhimista khatarta dhimashada wadnaha. Sidaas darteed daaweynta daaweynta xaaladaha noocaas ah marwalba had iyo jeer daaweynta doorashada.
Si kastaba ha noqotee, daaweynta revascularization inta badan waa xulasho wanaagsan marka la eego xaaladaha qaarkood. Kuwaas waxaa ka mid ah:
- Dadka qaba nooca wadnaha ee loo yaqaan 'ST-Segment' oo kor u qaada infakshanka 'myocardial infarction' (STEMI) .
- Dadka qaba hunguriga aan xasillooneyn ama aan lahayn ST-myocardial infarction (NSTEMI) , oo aan si dhakhso ah u deg degin daaweyn qalqalineed.
- Dadka qaba angina xasilloon oo aan si haboon u koontaroolin iyada oo daaweynta ugu badan ee daaweynta, ama aan u dulqaadan karin daaweynta caafimaad ee loo baahan yahay si loo xakameeyo.
- Dadka ay qiyaasta daawada CAD-du soo saartey qaybtaas oo dib-u-kicin laga yaabo inay ka badan tahay daaweynta caafimaadka si loo wanaajiyo badbaadada. Kuwaas waxaa ka mid ah dadka xiran xannibaad muhiim ah oo ku jira xididadooda ugu muhiimsan ee ka soo baxa wadnaha, iyo kuwa haysta xanibaada halbowleed ee dhammaan saddexda xididada wadnaha ee muhiimka ah - dhinaca midigta, bidixda iyo dabaylaha gudniinka. Faahfaahin dheeraad ah ka sii akhri arimaha koronerka arteriya .
Goorma Mawqiyeyaashu waxay doorbidaan CABG?
Marka la go'aamiyo in dib-u-celinta loo baahan yahay, go'aanka xigta ayaa ah inuu isticmaalo angioplasty iyo stenting, ama CABG.
Cadaadiska guud ahaan ayaa doorbidaya CABG ee bukaanka qaba STEMI, maaddaama ay tahay habka ugu dhakhsaha badan ee loo furo halista xididada wadnaha ee xidhan. Nidaamku wuxuu sidoo kale doorbidaa dadka qaba noocyada kale ee cudurrada daba-goyska (ACS, sida NSTEMI ama angina aan xasillooneyn), marka si deg deg ah loo furo xididka halista ah ee xididada loo arko in loo baahan yahay.
Dadka qaba angina xasilloon oo ku fashilantay daaweynta caafimaadka, stenting ayaa guud ahaan doorbideysa kuwa qaba CAD-ga oo ku lug leh halbowlaha halbowlaha.
Kuwa qaba hunguriga xasilloon ee u baahan uur-ku-noolaansho iyo haysato CAD-ga laba-farsamo, stenting ayaa guud ahaan lagu talinayaa haddii aysan waligood qabin cudurka sonkorowga, ama astaamahooda dabiiciga ah ee loo yaqaan 'coronary artery anatomy' ayaa loo arkaa inay adag tahay.
Goorma ayuu CABG u doorbidayaa Stents?
CABG waxaa la aaminsan yahay in uu keeno natiijooyin ka soo-baxa mudada fog ee dadka qaba CAD-ga 3-ta.
CABG waxaa loo maleynayaa inay sidoo kale bixiso natiijooyin ka fiican marka loo eego dadka badankooda qaba cudurka halbowlaha wadnaha ee ugu muhiimsan. Si kastaba ha noqotee, kuwa qaba ACS sababtoo ah xannibaad ku dhaca xididka bidix ee ugu wayn, stenting ayaa laga yaabaa inay noqoto mid amaan ah tan iyo markii la samayn karo si dhakhso ah.
CABG waa ikhtiyaar ka fiican marka loo eego dadka qaba 2-vessel CAD oo sidoo kale qaba sonkorow.
Ugu dambayn, guud ahaan, dadka dib loo eego CABG ayaa si yar u baahan baahida loo qabo revascularization ka badan kuwa kuwa qaata stents. Sababtan awgeed, CABG waa in ugu yaraan la falanqeeyaa sida ikhtiyaar u leh qof kasta oo u baahan baahida revascularization.
Maxkamadaynta SYNTAX
Haddii aan doonayno inaanu soo koobno xaaladaha CABG-da la door bido ka-reebista, waxaan dhihi karnaa in natiijooyinka ay u fiicnaanayaan CABG dadka ku haysta "cirif" CAD. "Complex" CAD waxaa ku jira dadka qaba cudurka 3-cudur, oo ka tagay CAD, dadka qaarkiis oo qaba cudurka 2-cudur, iyo ku dhowaad qofkasta oo qaba sonkorowga leh CAD.
Dacwada SYNTAX, oo la daabacay 2009, ayaa ah tijaabada kiliinikada ee la kala doortay si loo barbardhigo stent-ka CABG ee bukaannada qaba CAD. Daraasadani waxay muujisay in bukaanada la daweeyey CABG ay si weyn u yareeyeen dhacdooyinka dhimashada, dhimashada, wadnaha, wadnaha, iyo baahida loo qabo in lagu celiyo revascularization) marka loo eego bukaanka qaata stents (12.4% vs 17.8% 12 bilood kadib). Natiijooyin kuwan la mid ah ayaa lagu soo gudbiyay maxkamad ballaaran 2015-ka.
Sidaa daraadeed, labadii tijaabo ee kiliinikada lagu kala duwanaa ee la barbardhigay stents-ka CABG ee bukaannada qaba CAD-yada culus ayaa labaduba u soo baxeen iyagoo raalli gelinaya CABG.
Dhakhtarrada wadnaha ayaa tilmaamaya, in kastoo tijaabada SYNTAX, halka ay dhammaadkii dhammaystirnayd ay ka sii xumaatay stent, khatarta gaabiska ee gaabisku u muuqato ka sareeya kadib CABG (0.6% stents iyo 2.2% ee CABG) 12 bilood kadib. Tani waa qodob sharci ah, inkastoo khatarta istarooggu uu ahaa mid u dhigma labada kooxood saddex sano ka dib.
Baadhayaasha ka shaqeynaya tijaabada SYNTAX ayaa tan iyo markii ay soo baxeen waxa ay ku magacaabeen "dhibco SYNTAX", taas oo astaan u ah qiyamka CAD-da bukaanka marka loo eego murugsanaantooda. Bukaannada leh dhibcaha hoose ee SYNTAX waxay u muuqdaan inay si ka fiican u sameeyaan stent ka badan kuwa leh dhibcaha SYNTAX. Si kastaba ha ahaatee, halka badan oo dhakhaatiirta wadnaha ah ay isticmaalaan dhibcaha SYNTAX si ay uga caawiyaan in ay go'aan ka gaaraan in qof leh CAD-adag oo adag ay tahay inuu heysto ama CABG, nidaamkan dhibcaha laftiisa looma imtixaanin tijaabada baaritaanka.
Khadadka hoose
Qeybta ugu hooseysa ayaa ah in dadka badankooda u baahan yihiin dib u eegis ku dhaca xididada wadnaha, iyo kuwa leh khatar saddexlaaladood oo khatar ah ama calaamad weyn oo ku jirta halbowlaha wadnaha ee ugu muhiimsan, CABG badanaa waa in loo tixgeliyaa qaabka ugu horeeya ee daaweynta.
Cadaadiska guud ahaan wuxuu doorbidaa dadka qaba ACS, dadka qaba CAD-ga hal-gaaban, iyo dad badan oo qaba 2-vessel CAD oo aan lahayn sokor.
Isticmaalka stent halkii CABG loogu talagalay CAD-gaaban waa in loogu tala galay dadka, ka dib marka la fahmo khatarta iyo faa'iidooyinka, haddana waxay doortaan habka yar ee waxqabad la'aanta ah.
> Ilo:
> Farooq V, van Klaveren D, Steyerberg EW, et al. Astaamaha Calaamadaha Cudurrada iyo Xarumaha Cilmi-baarista ee Hagaha Go'aanka Goynta Qalitaanka Qalitaanka Cudurka Qalitaanka iyo Qalabka Ciladaha Perkansan ee Bukaanka Shaqsiga: Horumarinta iyo Hubinta Dhibcaha Dhibcaha II. Lancet 2013; 381: 639.
> Park SJ, Ahn JM, Kim YH, et al. Maxkamadeynta Everolimus-Eluting Stents ama Qaliinka Qaliinka ee Cudurka Wadnaha. N Engl J Med 2015; 372: 1204.
> Serruys P, Morice MC, Kappetein P, et al. Cudurka Dabaysha Qalitaanka Cudurka Dhiig-baxa ee Virus Cudurka Versus Coronary-Artery Bypass Grafting ee Cudurka Halista ah ee Halista ah. N Engl J Med 2009; 360: 961-972.